16 March 2020

Page last updated on Wednesday 23 March 2022 at 20:52.

Outpatient appointments

There are restrictions on the number of outpatients that we can bring into Royal Papworth Hospital in order to keep all patients within the hospital safe.  

We will contact you before your next appointment and let you know whether we will see you in person or whether we will convert your appointment to a virtual appointment. Please do not just turn up to the hospital. 

If we are unable to see you in person, then we may ask you to have blood tests performed locally. If you are uncertain whether you should attend your appointment, please contact the transplant unit on 01223 638007. 

If you still have a question after reading the FAQs below, please email the transplant continuining care team.
 

Latest FAQs

Am I at an increased risk from COVID-19? 
What about the Omicron and BA.2 variant?
Should I be vaccinated against COVID-19?
Will I respond to COVID-19 vaccination?
Does vaccination reduce the risk of COVID-19 in transplant patients?
Are treatments available to reduce my risk of catching COVID-19?
What else can I do to reduce my risk from COVID-19?
What should I do if I feel unwell?
What should happen if I test positive for COVID-19?
What treatments are available if I test positive for COVID-19?
Should I attend my outpatient appointment?
Are you still performing transplants?
Will I still be able to access my medicines / do I need to stockpile?

How you can help.


Am I at an increased risk from COVID-19? 

Transplant patients are ‘clinically extremely vulnerable’. According to data collected by NHS Blood and Transplant, 22.7% of heart transplant recipients and 22.6% of lung transplant recipients had tested positive for COVID-19 by 9 March 2022. Sadly, 7.5% of heart transplant patients and 15.5% of lung transplant patients died within 28 days of a positive COVID-19 test.

Transplant patients may be at particularly high risk if they have graft damage that has occurred since transplant or have another risk factor such as: older age; being from a Black, Asian or minority ethnic group; obesity; or kidney problems. Lung transplant patients who require oxygen or NIV are likely to be at the highest risk.

Patients with chronic heart or lung disease are also at increased risk of developing severe COVID-19, so we believe that patients who are waiting for heart or lung transplantation should also be classed as ‘clinically extremely vulnerable’.


What about the Omicron and BA.2 variant?

New variants of coronavirus emerge all the time, particularly in unvaccinated populations. The Omicron variant emerged in November 2021 and has rapidly spread to become the dominant variant in most countries of the world. Omicron is more transmissible than the previous dominant variant (Delta) but causes milder illness. A sub-variant of Omicron called BA.2 has recently emerged and may be more transmissible still.


Should I be vaccinated against COVID-19?

Yes. We strongly recommend that you and eligible members of your household are vaccinated. More than 140 million doses of the AstraZeneca, Pfizer and Moderna COVID-19 vaccines have been administered in the UK and 85.6% of those aged 12 or over are fully vaccinated.

COVID-19 vaccines use new technology. The Pfizer and Moderna vaccines use a piece of genetic material (mRNA) for spike protein, a surface protein on the COVID-19 virus. The AstraZeneca vaccine also uses genetic material for spike protein but this is delivered using an inactivated chimpanzee adenovirus. Vaccines offer protection if you subsequently encounter the COVID-19 virus, either by preventing or reducing the severity of illness. There are very rare side effects from COVID-19 vaccines but they are safe for transplant patients. We do not suggest any changes to your immunosuppression at the time of vaccination.

Adults who are immunosuppressed, such as transplant patients, should get three vaccine doses for their primary course of vaccination.

Once a transplant patient has received all three primary vaccine doses, then subsequent doses of vaccine are called a booster. Transplant patients received their fourth dose (first booster) in late 2021 and will be offered a further booster dose from March 2022.


Will I respond to COVID-19 vaccination?

It is important to acknowledge that all vaccines, including the COVID-19 vaccines, are less effective in immunosupressed patients. Studies have shown that around one-third of transplant patients have no detectable antibody response to COVID-19, even after a third dose of vaccine. However, it is possible that the cellular response to vaccination (which cannot be easily measured) is more important than the antibody response.

We can measure your COVID-19 antibody levels at your next outpatient appointment if you wish. This helps us understand your response to vaccination and may help us advise you about treatments if you catch COVID-19. It is important to understand that an antibody test does not tell you whether you are ‘safe’ from COVID-19.

If you are interested in knowing more about COVID-19 antibody levels, then please consider joining the MELODY study, which aims to recruit people who have received solid organ transplants. 


Does vaccination reduce the risk of COVID-19 in transplant patients?

This is a very difficult question to answer. 

NHS Blood and Transplant and the UK Health Security Agency have been monitoring COVID-19 in all 40,000 transplant patients in the UK, as and when they have been vaccinated. Unfortunately, two doses of the vaccine does not reduce the risk of testing positive for COVID-19.  However, two doses of vaccine reduces the risk of dying of COVID-19 by around 20%. More information can be found on the NHSBT website.

COVID-19 vaccines are also thought to offer less protection against Omicron than previous variants, particularly if an individual’s last vaccine dose was more than three months ago. An enhanced booster programme has been in place in the UK since December 2021 for this reason. We hope that a third primary vaccine dose and subsequent booster dose may increase protection for transplant patients.
 

Are treatments available to reduce my risk of catching COVID-19?

Yes. New treatments are now available to reduce your risk of catching COVID-19.

Evusheld is a combination of two monoclonal antibodies (Tixagevimab and Cilgavimab) and has been developed by AstraZeneca. Evusheld contains long-acting antibodies that bind the spike protein on the outside of the COVID-19 virus and prevent it from entering cells.

In a clinical trial, Evusheld reduced the risk of developing symptomatic COVID-19 by 77%, with protection continuing for six months. Early laboratory data suggest that Evusheld retains protection against the Omicron variant and BA.2 sub-variant.

Evusheld was approved for pre-exposure prophylaxis (prevention) of COVID-19 by the Medicines and Healthcare Regulatory Agency (MHRA) on 17 March 2022. It is approved for use in adults who are unlikely to mount an immune response to COVID-19 vaccination, such as transplant patients. NICE guidance with regard to Evusheld is awaited and we will let you know once the treatment is available for use in the United Kingdom. 
 

What else can I do to reduce my risk from COVID-19?

We recommend that you follow national guidance to keep safe and reduce spread of the virus. The guidance changes frequently and it is important to keep updated. Current guidance for people whose immune system means they are at higher risk.

  • Ensure you have had all of the vaccines you are eligible to receive, including your booster COVID-19 vaccination.
  • Consider continuing to wear a face covering in public spaces.
  • Work from home if this feels right for you – if you cannot work from home, speak to your employer about what arrangements they can make to reduce your risk.
  • Reduce the time you spend in enclosed crowded spaces.
  • Practice social distancing if that feels right for you.
  • Ventilate your home by opening windows and doors to let fresh air in.
  • Consider asking friends and family to take a rapid lateral flow antigen test before visiting you.
  • Ask home visitors to wear face coverings and wear a face covering yourself.
  • Wash your hands regularly and avoid touching your face.
  • Regular spirometry is recommended for lung transplant patients.
  • Consider downloading the NHS COVID-19 app.

Finally, we recommend that you keep a PCR test kit at home, so you can do a rapid PCR test if you develop symptoms. NHS Test and Trace will send you a home PCR test kit if you are an immunosuppressed patient. If you have not received a home PCR test kit, call 119 for advice. 

You can find PCR home test kit instructions for people eligible for COVID-19 treatments on GOV.UK.
 

What should I do if I feel unwell?

If you develop fever, cough or difficulty breathing you should perform a PCR test and report the result as instructed. If you do not have a PCR test at home, then you must urgently get a free PCR test.

Symptoms of COVID-19 may be similar to other problems in transplant patients. Please call the transplant unit on 01223 638007 if you wish to discuss your symptoms. If you are unwell or a lung transplant patient with a drop in lung function, then you may be advised to go to hospital. 

If you are advised to come to Royal Papworth Hospital, please stay in your car and call the transplant unit nurses on 07775 587395 when you arrive.

Do not enter the hospital without first making contact with the transplant team.


What should happen if I test positive for COVID-19?

If you report a positive PCR test, you should be called within 24 hours by an expert clinician from your local NHS COVID Medicines Delivery Unit (CMDU) who will discuss the most appropriate treatment. These treatments are described in detail below.

Please contact the transplant unit on 01223 638007 to let us know that you have COVID-19. Do not stop taking your immunosuppression; we will tell you if your medications need to change. Whilst there is no longer a legal requirement to self-isolate, you should stay at home and avoid contact with other people. This helps reduce the chance of passing on COVID-19 to others.

Further guidance for people with COVID-19 and their contacts.

Please contact us if your symptoms worsen. Depending on your circumstances, we may ask you to call NHS 111 or use NHS 111 online.

If you develop life-threatening symptoms such as difficulty in breathing, blue lips, pale/blotchy skin, collapse or drowsiness/confusion, immediately dial 999 and tell the operator that you have COVID-19.


What treatments are available if I test positive for COVID-19?

New treatments are becoming available for COVID-19 all the time and the NHS is trying to deliver these treatments outside hospital where possible. This is a rapidly evolving area and the best treatment option is likely to vary from patient to patient. 

Sotrovimab is a neutralising monoclonal antibody and is given as an intravenous infusion. It sticks to the COVID-19 virus and stops it from getting into your lungs. Molnupiravir is a tablet that interferes with viral replication. Both medications reduce the risk of severe COVID-19. They are recommended as soon as possible after a positive COVID-19 PCR test and within five days of symptom onset.

Transplant patients are eligible for treatment with Sotrovimab and Molnupiravir. Both treatments are available from your local CMDU. If you report a positive PCR test, then an expert clinician from your local CMDU will call you to discuss the most appropriate treatment. Sotrovimab will be given at the CMDU, while Molnupiravir can be collected or delivered to your home.

More information about getting Sotrovimab and Molnupiravir.

A treatment called Paxlovid (Nirmatrelvir and Ritonavir) is not appropriate for transplant patients because it interacts with immunosuppression. For the most unwell patients who are admitted to hospital, other treatments such as Dexamethasone, Remdesivir, Tocilizumab and Sarilumab may be considered by the doctors looking after you. These medications are safe for transplant patients.
 

Should I attend my outpatient appointment?

There are restrictions on the number of outpatients that we can bring into Royal Papworth Hospital in order to keep all patients and staff safe within our hospital.

We will contact you before your next appointment and let you know whether we will see you in person or whether we will convert your appointment to a 'virtual' appointment. If we are unable to see you in person then we may ask you to have blood tests performed locally.

If you are uncertain whether you should attend your appointment, please contact the transplant unit on 01223 638007 before you travel to Royal Papworth Hospital.
 

Are you still performing transplants?

Our programme has remained open for heart and lung transplantation throughout the pandemic. Although we prioritised our most unwell patients during the peaks of the pandemic, our programme has returned to standard pre-pandemic practice. We are confident that we can safely perform transplants and protect immunosuppressed patients in our hospital.

There are COVID-19 patients in our hospital at the moment and the number will inevitably increase during future waves. It is still possible that we may be unable to do a transplant because of ‘logistical’ problems on the day or night, such as lack of an intensive care unit bed after the operation.

We keep the situation under regular review. Like all transplant units, we would only stop transplantation as a last resort. This might happen if our hospital became too full to be safe or if there were severe staff shortages.
 

Will I still be able to access my medicines / do I need to stockpile?

We continue to work closely with our NHS partners (e.g. Homecare) to make sure we have enough supplies of medicines for our patients. If you are currently receiving medicines such as anti-rejection medication from Homecare, this will continue. The main change people may experience is that drivers may not ask for a signature and may stay a safe distance away from patients by setting the parcel down and then walking away and waiting for the recipient to pick up the parcel. No medicines will be left unattended.

Please see our pharmacy COVID-19 page for more information. 


How you can help.

As usual, make sure you have enough ‘buffer stock’ by keeping at least two to four weeks’ worth of your medicines at all times, and requesting repeat prescriptions or Homecare deliveries well in advance of this supply running out. That will give your pharmacy or Homecare provider enough time to deal with any shortages should they arise. This is standard practice for our patients and not new advice.

If you are experiencing any difficulty getting hold of a supply of your medicines, or if you have any concerns about their availability, please let the transplant continuing care team know as soon as possible by emailing papworth.transplant.continuingcare@nhs.net.